Pediatric Respiratory Anatomy and Physiology: Understanding Developmental Variances

The child with respiratory Alteration The child with respiratory Alteration Lecture 3, Part one

Anatomy of the Respiratory System 16/04/2025 2

Anatomy of the Respiratory System (cont.) What is respiration? Respiration is the act of breathing: inhaling (inspiration) - taking in oxygen. exhaling (expiration) - giving off carbon dioxide. What makes up the respiratory system? The respiratory system is made up of the organs involved in the interchanges of gases, and consists of the: - nose - pharynx - larynx - trachea - bronchi - lungs 16/04/2025 3

Anatomy of the Respiratory System (cont.) The upper respiratory tract includes the following: nose nasal cavity Sinuses: ethmoid, frontal, maxillary, sphenoid larynx trachea The lower respiratory tract includes the following: lungs airways (bronchi and bronchioles) air sacs (alveoli) 16/04/2025 4

Variations in Pediatric Anatomy and Physiology Nose Newborns are obligatory nose breathers until at least 4 weeks of age. Throat The tongue of the infant relative to the oropharynx is larger than in adults. Trachea The airway lumen is smaller in infants and children than in adults. The infant s trachea is approximately 4 mm wide compared with the adult width of 20 mm. 16/04/2025 5

Variations in Pediatric Anatomy and Physiology Fewer alveoli Constantly Growing Alveoli Increase in Number & Size Until 12 yr Primarily diaphragmatic breathers until ~ 6 yr Increased chest compliance: poor expansion & decreased lung volume The bifurcation of the trachea occurs at the level of the third thoracic vertebra in children, compared to the level of the sixth thoracic vertebra in adults 16/04/2025 6

Variations in Pediatric Anatomy and Physiology infants are born with about 50 million alveoli. After birth, alveolar growth slows until 3 months of age and then progresses until the child reaches 7 or 8 years of age, at which time the alveoli reach the adult number of around 300 million. place the child at a higher risk of hypoxemia

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ASSESSMENT Observation Level of Consciousness, Activity; Awareness Skin Color: Pink, Pale. Cough : dry, wet, forceful or week Child with Mild Cyanosis 16/04/2025 9

ASSESSMENT Observation (cont.) Respiratory Rate & Work of Breathing Grunting: Audible at End of Expiration; Attempt to Keep Airway Open http://www.youtube.com/watch?v=XgdGRP-xVfM Stridor: High-pitched sound produced by an obstruction of the trachea or larynx that can be heard at inspiration or expiration. Nasal Flaring: Nostrils Flare in Attempt to Increase Airway Diameter Retractions: Chest Wall is Drawn Inward During Inspiration Due to Flexible (Cartilage) Airway 16/04/2025 10

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Location of Retractions 16/04/2025 12

ASSESSMENT Auscultation CRACKLES: Coarse or Fine; Related to Fluid in Airway (Pneumonia, CHF) WHEEZES: Musical Sound Related to Turbulent Airflow in Constricted Airway (Asthma) DESCRIBE Location of Retractions & Adventitious Airway Sounds; Use LANDMARKS 16/04/2025 13

UPPER RESPIRATORY TRACT INFECTION 16/04/2025 14

Nasopharyngitis Nasopharyngitis: Common cold . Causes: rhinovirus, adenovirus, influenza virus, Resp. syncytial virus (RSV), Para influenza virus. Clinical manifestations: fever, irritability, restlessness, sneezing, vomiting, diarrhea. dryness, irritation of nose, & Throat, cough, sneezing , chilly sensation, muscular aches. Physical signs: edema& vasodilatation of mucosa. 16/04/2025 15

Nasopharyngitis http://tgp.com.ph/blog/wp-content/uploads/2015/06/tonsillitis-viral-bacterial.jpg https://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcTfutbes2nhjKbwWvTVE8FUO4i4mICm5QHqgCUQMWxe8Ds6nIh_mg

Nasopharyngitis (cont.) Therapeutic management: Mostly treated at home , no vaccine, antipyretics for fever. Decongestants: nose drops more effective than orally. Cough: suppressant. Antihistamine are ineffective. Antibiotic: usually not indication. Nursing consideration: For nasal obstruction: elevate head of bed, suctioning and vaporization, saline nasal drops. Maintain adequate fluid intake to prevent dehydration. Avoiding spread the virus. 16/04/2025 17

Pharyngitis Causes : 80-90%of cases are viral cause , other is group A and B hemolytic streptococci Clinical manifestation: - May be mild so no symptoms. - Headache, fever, abdominal pain exudates on pharynx& tonsils, 3-5 days usually symptoms are subside Complication if not treated : - Acute glumerulonephritis syndrome in about 10 days. 16/04/2025 18

Pharyngitis (cont.) Diagnostic evaluation: throat culture should be performed to rule out. Therapeutic management: - If streptococcal sore throat infection: oral Penicillin for 10 days ,or IM Benzathine penicillin G. - Oral Erythromycin if the child has allergy to penicillin. Nursing consideration: - Obtain throat swab for culture. - Administer penicillin & analgesic. - Cold or warm compresses to the neck may provide relief. 16/04/2025 - Warm saline gargles. 19

Pharyngitis (cont.) Nursing consideration (cont.) - Soft liquid food are more acceptable than solid. - Continue oral medication to complete the course. - IM injection applied in deep muscle as vastus lateralis or ventrogluteal muscle, use Emla cream before IM around 2 hours. - Nurse role to prevent the spread of disease. - Children are considered non infectious to other 24 hours after initiation of antibiotics therapy. 16/04/2025 20

Tonsillitis Tonsils are masses of lymphoid tissue, first immune defense. Tonsillitis often occur with pharyngitis, viral or bacterial causes. S& S: - enlarge tonsils, difficult breathing & swallow. - Enlargement of adenoid, blocked postnasal space &mouth breathing. 16/04/2025 21

Tonsillitis http://dfwsinus.com/wp-content/uploads/2015/02/Enlarged-Tonsils-and-Adenoids-1024x569.jpg http://176.32.230.21/guildfordent.co.uk/wp-content/uploads/2013/08/img2031.png

Tonsillitis Therapeutic management: - throat culture to determine the causative agent ,viral or bacterial - Tonsillectomy & adenoidectomy (T&S) - Contraindicating for Ts &As: cleft palate, tonsillitis, blood disorder. Nursing consideration: Providing comfort & maintain minimize activities. A soft or liquid diet is prescribed. Warm salt water gargles Analgesic, antipyretic. 16/04/2025 23

Tonsillitis Post operative care: Position (place child on abdomen or side). Discourage child from coughing frequency. Some secretion are common as dried blood. Crushed ice& ice water to relief pain. Analgesic may be rectally or IV, avoid oral route. 16/04/2025 24

Tonsillitis Post operative care (cont.): Soft food, milk or ice cream Check post operative signs of Hemorrhage: - Increase pulse more than 120b/min. - Pallor. - Frequent swallowing. - Vomiting of bright blood - Decrease blood pressure is late sign of shock. Note: use good light to look direct on site of operation. 16/04/2025 25

Otitis Media:OM OM is inflammation of middle ear. Episode of acute OM occur in the first 24 month, decrease at 5 years, r/to drainage through the Eustachian tube & inflammatory of Resp. system. Etiology: - Acute (AOM): streptococcus, Haemophilus influenza, moraxella catarrhlis, are the most common bacteria. - OM: blocked Eustachian tube from edema of URTI , allergic hypertrophy adenoid. - Chronic (COM): extension of AOM. 16/04/2025 26

Otitis Media:OM (cont.) Diagnostic evaluation: assessment of tympanic membrane with otoscope:- AOM: purulent discolored effusion, bulging S&S: otalgia (earache), fever, purulent discharge, infant rolls his head from side to side, loss of appetite, crying or verbalized feeling of discomfort (older child). COM: hearing loss, feeling of fullness, vertigo, tinnitus. 16/04/2025 27

Otitis Media:OM (cont.) Therapeutic management: - Antibiotic for 10-14 days e.g. Amoxicillin. - Myringotomy: surgical incision of eardrum& grommets. - Hear test after 3 month of AOM. Nursing consideration: Relieving pain. analgesic drug +ice bag on ear. Facilitate drainage & topical A.Biotics. Preventing complication. Instruct family to be careful when deal with child. With temporary hearing loss. Preventing OM during infant feeding and setting after that. 28

Otitis Media:OM

Lower Respiratory Tract Infections 16/04/2025 30

Infection of the Lower Air ways Cartilaginous support of the air ways is not fully developed until adolescence, consequently the smooth muscle in these structures represents a major factor in the constriction of the airway. 16/04/2025 31

Bronchitis Bronchitis or tracheobronchitis is inflammation of larger air way (trachea and bronchi). Causative agents: viruses or mycoplasma pneumonia. Ch-ch & symptoms: dry, nonproductive cough that worsens at night then become productive in 2-3 days. Bronchitis is a mild disease required symptomatic treatment as antipyretic, analgesic and humidity, cough suppressants may be useful at night. 16/04/2025 32

Bronchiolitis & Resp. Syncytial Virus RSV Bronchiolitis: is an acute viral infection with maximum effect at the bronchiolar level, and rare in children older of 2 years. One of the Most Frequent Cause of Hospitalization in Infants Virus or Bacteria Causes Inflammatory Response & Obstruction of Small Airways From Edema RSV is responsible of 80% of cases during epidemic periods. 16/04/2025 34

Pneumonia Pneumonia: is inflammation of the pulmonary parenchyma. Common in children but more frequently occur in infancy & early childhood. Types of pneumonia (depend on place): Lobar- Pneumonia: one-lobe or more (bilateral or double Pneumonia). Broncho Pneumonia: begins in the terminal bronchioles form consolidated patches in nearly lobules, also called lobular Pneumonia . Interstitial Pneumonia: inflammatory process is confined within 16/04/2025 the alveolar walls and peribronchial and interlobular tissues. 35

Pneumonia (cont.) Morphology classification: viral, bacterial, mycoplasma , aspiration of foreign body, fungal. Viral Pneumonia: Occurs more than bacterial. Causes: RSV, parainfluenza, influenza, adenovirus. Clinical symptoms: fever, cough, abnormal breath sound; whitish sputum, nasal flaring, retraction, chest pain, pallor to cyanosis, irritable, restless, anorexia, vomiting, diarrhea, abdominal pain. 16/04/2025 36

Pneumonia (cont.) Viral Pneumonia (cont.): Treatment: - symptomatic: O2 therapy, Comfort. - Chest physiotherapy and postural drainage. - Antipyretics, Fluid intake, & Family supports. http://www.newhealthadvisor.com/images/1HT03450/pneumonia.png https://upload.wikimedia.org/wikipedia/commons/a/ac/PneumonisWedge09.JPG 16/04/2025 37

Bacterial Pneumonia Streptococcus Pneumonia is the most common cause in children and adult In infant mainly followed viral infection. Symptoms: fever, malaise, rapid& shallow respiration, cough, chest pain, abdominal pain?? Appendicitis, meningeal symptoms. Treatment: bed rest, antipyretic, fluid intake, need hospitalization when pleural effusion or empyema, I.V fluid, O2 therapy. 16/04/2025 38

Bacterial Pneumonia (cont.) Complication: - Tension pneumothorax and empyema if the causative agent is staphelococcus auoraus, - lung abscess if pnumococcal pneumonia. Prognosis: is generally good if recognize the disease early & treat early. Prevention: pnumococcal poysaetheride vaccine for 16/04/2025 children older than 2 years who is risk. 39

Bacterial Pneumonia (cont.) Nursing consideration: Administer of O2 therapy , rest, humidity. Assess Resp. status frequently. I.V fluid intake. Antipyretic. Lying the child on affected side. Suctioning by bulb syringe for infant. Chest physiotherapy & postural drainage. Family support & reassurance. 16/04/2025 40